Serious adverse events were rare; occurred in both the tacrolimus and corticosteroid groups; and in most cases, were considered to be unrelated to the treatment. No cases of lymphoma were noted in the included studies nor in the non-comparative studies. Cases were only noted in spontaneous reports, cohorts, and case- control studies. Systemic absorption was rarely detectable, only in low levels, and this decreased with time. Exception is made for diseases with severe barrier defects, such as Netherton's syndrome, lamellar ichthyosis, and a few others, with case reports of a higher absorption. We evaluated clinical trials; case reports; and in vivo, in vitro, and animal studies; and didn't find any evidence that topical tacrolimus could cause skin atrophy .
Articular damage in the foot in RA is the result of synovitis compounded by the considerable mechanical stresses occurring in this weightbearing structure. When un- or undertreated, synovitis combined with mechanical stress in the subtalar and talonavicular joints results in characteristic irreversible structural changes such as flattening of the medial longitudinal arch, valgus deformity of the calcaneus, and tibialis posterior dysfunction. 8,13,14 With better disease-modifying anti-rheumatic drug (DMARD) therapy and earlier intervention, this classic ‘rheumatoid foot’ is likely to become less common, although it must be remembered that not all patients do well, even on biologics. Furthermore, in a small proportion of cases our experience is that good disease control elsewhere in the body is not matched by equally good disease control in the weightbearing joints of the feet.